Illicit drug use may lead to dependence on those drugs, is associated with various psychiatric disorders, and can have hazardous, sometimes life-threatening, consequences. We investigated the genetic architecture underlying the lifetime use (LU) of several drugs, individually and in combination.

We conducted genome-wide association studies of LU of cocaine, methamphetamine, inhalants, illegal opioids, prescription opioids, and prescription stimulants in European (EUR), African (AFR), and Latin American (AMR)-ancestry subjects (cases ranging from n = 4,900–21,850 [EUR], n = 519–9,802 [AFR], and n = 899–5,012 [AMR]; controls from n = 93,763–110,658 [EUR], n = 37,261–46,509 [AFR], and n = 31,412–35,501 [AMR]). We also investigated the use of illicit drugs of any kind and the total count of drugs a person has ever used. Then, we assessed the global and local genetic correlations between substance LU (SubLU) traits and their genetic correlations with other traits.

We found numerous genes that affect SubLU traits, with no overlap among the significant loci between traits, suggesting that unique genetic factors may differentially affect the use of different drugs. Nevertheless, the genetic correlations between SubLU traits were very strong; however, the phenotypic correlations were moderate. There were strong genetic correlations between various SubLU traits and psychiatric traits, most notably opioid use disorder, cannabis use disorder, problematic alcohol use, and suicidality.

Our findings provide insights into the genetic basis of substance use, identifying several novel genes associated with SubLU traits. This study can provide an improved understanding of the biology underlying SubLU and could potentially facilitate future risk assessments for the use of illicit and hazardous drugs.

About 13% of pregnant women with substance use disorder (SUD) receive treatment and many may encounter challenges in accessing perinatal care, making it critical for this population to receive uninterrupted care during a global pandemic.

From October 2021-January 2022, we conducted an online survey of pregnant and postpartum women and interviews with clinicians who provide care to this population. The survey was administered to pregnant and postpartum women who used substances or received SUD treatment during the COVID-19 pandemic.

Two hundred and ten respondents completed the survey. All respondents experienced pandemic-related barriers to routine health care services, including delays in prenatal care and SUD treatment. Disruptions in treatment were due to patient factors (38.2% canceled an appointment) and clinic factors (25.5% had a clinic cancel their appointment). Respondents were generally satisfied with telehealth (M = 3.97, SD = 0.82), though half preferred a combination of in-person and telehealth visits. Clinicians reported telehealth improved health care access for patients, however barriers were still observed.

Although strategies were employed to mitigate barriers in care during COVID-19, pregnant and postpartum women who used substances still experienced barriers in receiving consistent care. Telehealth may be a useful adjunct to enhance care access for pregnant and postpartum women during public health crises.

Advances in medicine have led to an improvement in life expectancy, thus increasing the population of older individuals within the criminal justice system. This study investigates the determinants of risk formulation, care plan, and disposition among older adult forensic patients (OAFP) in Ontario, Canada.

This retrospective analysis utilized the Ontario Review Board database, focusing on 161 OAFP, aged 55 years and older. Hierarchical regression was used to analyze the relationship between changes in risk and six blocks of variables: sociodemographic characteristics (Block 1), circumstances during the index offense (Block 2), current clinical profile (Block 3), past psychiatric history and behavioral patterns (Block 4), criminal history and legal status (Block 5), and recent violent events (Block 6).

The median age of patients was 61 years (IQR 58–67), with 83.4% being male. Schizophrenia was the most common diagnosis (68.3%), and 9.3% had neurocognitive disorders. The model with six blocks of factors explained 92% of the variability in risk change. Models 2 (blocks 1 and 2) and 4 (blocks 1–4) were statistically significant, explaining 34% (p = 0.010) and 22% (p = 0.018) of the variance in the change in risk of threat to public safety, respectively. OAFP with a significant risk to public safety were more likely to be inpatients and less likely intoxicated during their index offense.

Resources, policies, and a supervised model of care to curtail behavioral risks are relevant to the care of OAFP. Innovative risk management models for OAFP are indicated.

The prevalence of alcohol use disorder among older adults is increasing, with this population being particularly vulnerable to alcohol’s detrimental effects. While knowledge of preventative factors is scarce, physical activity has emerged as a potential modifiable protective factor. This study aimed to examine associations between alcohol consumption and physical activity in a large-scale, multi-national prospective study of the older adult population.

Longitudinal data from the SHARE study on physical activity, alcohol consumption, demographic, socioeconomic, and health variables, were analyzed in older adults. Individual-level data were examined using logistic regression models. Both cross-sectional and longitudinal models were calculated to account for potential latency in the association between physical activity and alcohol consumption.

The study included 3133 participants from 13 countries. Higher physical activity levels were significantly associated with higher alcohol consumption in cross-sectional (p = 0.0004) and longitudinal analyses (p = 0.0045) over a median follow-up of 6 years. While the presence of depressive symptoms and higher educational attainment were associated with higher alcohol consumption, female sex and persons with lower perceived health showed lower frequency of alcohol consumption. Additionally, the country of residence also proved to be a relevant factor for alcohol consumption.

Higher levels of physical activity showed an association with higher alcohol consumption in older adults. Future research should investigate whether this association is causal and underpinned by neurobiological, social, or methodological factors.

Impulsivity is a multidimensional trait associated with substance use disorders (SUDs), but the relationship between distinct impulsivity facets and stages of substance use involvement remains unclear.

We used genomic structural equation modeling and genome-wide association studies (N = 79,729–903,147) to examine the latent genetic architecture of nine impulsivity traits and seven substance use (SU) and SUD traits.

We found that the SU and SUD factors were strongly genetically inter-correlated (rG=0.77) but their associations with impulsivity facets differed. Lack of premeditation, negative and positive urgency were equally positively genetically correlated with both the SU (rG=.0.30–0.50) and SUD (rG=0.38–0.46) factors; sensation seeking was more strongly genetically correlated with the SU factor (rG=0.27 versus rG=0.10); delay discounting was more strongly genetically correlated with the SUD factor (rG=0.31 versus rG=0.21); and lack of perseverance was only weakly genetically correlated with the SU factor (rG=0.10). After controlling for the genetic correlation between SU/SUD, we found that lack of premeditation was independently genetically associated with both the SU (β=0.42) and SUD factors (β=0.21); sensation seeking and positive urgency were independently genetically associated with the SU factor (β=0.48, β=0.33, respectively); and negative urgency and delay discounting were independently genetically associated with the SUD factor (β=0.33, β=0.36, respectively).

Our findings show that specific impulsivity facets confer risk for distinct stages of substance use involvement, with potential implications for SUDs prevention and treatment.

Prompt initial contact with a treatment provider is a critical first step in seeking help for a mental or substance use disorders (SUDs). The aim of the current study was to provide estimates of patterns and predictors of delay in making initial treatment contact based on the recently completed Australian National Survey of Mental Health and Wellbeing.

Data came a nationally representative epidemiological survey of n = 15,893 Australians. Measures included DSM-IV lifetime diagnoses of mood (MD), anxiety (AD) and SUDs; age of disorder onset; and age of first treatment contact. Correlates of treatment delay were examined.

SUDs exhibited the lowest lifetime treatment rate (27%), compared to MD (94%) and ADs (85%). Individuals with AD experienced the longest delay in seeking treatment (Mdn = 11 years), followed by those with SUDs (Mdn = 8 years) and MDs (Mdn = 3 years). Females had higher odds of seeking treatment for MD and AD but lower odds for SUDs. Recent birth cohorts showed increased treatment seeking across disorders, and higher education was associated with increased treatment seeking for MD and AD. Age of onset, country of birth and co-occurring disorders had mixed associations with treatment seeking.

The study reveals stark disparities in treatment-seeking behaviour and delays across mental and substance use disorders, with a pronounced underutilization of services for SUDs. Additionally, attention should be directed towards early intervention for individuals with earlier symptom onset, those from earlier cohorts and those with co-occurring SUDs.

Adolescence is a critical period for preventing substance use and mental health concerns, often targeted through separate school-based programs. However, co-occurrence is common and is related to worse outcomes. This study explores prevention effects of leading school-based prevention programs on co-occurring alcohol use and psychological distress.

Data from two Australian cluster randomized trials involving 8576 students in 97 schools were harmonized for analysis. Students received either health education (control) or one of five prevention programs (e.g. Climate Schools, PreVenture) with assessments at baseline and 6, 12, 24, and 30 or 36 months (from ages ~13–16). Multilevel multinomial regressions were used to predict the relative risk ratios (RRs) of students reporting co-occurring early alcohol use and psychological distress, alcohol use only, distress only, or neither (reference) across programs.

The combined Climate Schools: Alcohol and Cannabis and Climate Schools: Mental Health courses (CSC) as well as the PreVenture program reduced the risk of adolescents reporting co-occurring alcohol use and psychological distress (36 months RRCSC = 0.37; RRPreVenture = 0.22). Other evaluated programs (excluding Climate Schools: Mental Health) only appeared effective for reducing the risk of alcohol use that occurred without distress.

Evidence-based programs exist that reduce the risk of early alcohol use with and without co-occurring psychological distress, though preventing psychological distress alone requires further exploration. Prevention programs appear to have different effects depending on whether alcohol use and distress present on their own or together, thus suggesting the need for tailored prevention strategies.

To describe and compare the prevalence of psychosocial and psychiatric disorders among veterans with multiple sclerosis (MS) and a propensity-score-matched group of veterans without MS, and to identify sociodemographic and clinical characteristics associated with comorbid psychosocial and psychiatric problems among veterans with MS.

Data were linked and extracted from the Veterans Affairs (VA) Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. The total sample comprised 27,342 veterans in the VA healthcare system between January 1, 2022, and June 30, 2023, who met eligibility criteria for an MS diagnosis (n=13,671) and 1:1 propensity-score-matched sample of veterans who did not have MS (n=13,671). MS diagnosis, substance use disorder (SUD), mental illness, and homelessness were defined using standard ICD-10 codes. Covariates included sex, age, Charlson Comorbidity Index (CCI), and VA service-connected disability rating.

A higher prevalence of mental illness among veterans with MS (33%) was found compared with those without MS (31%). Multivariable logistic regression models indicated MS was negatively associated with diagnoses of alcohol use disorder, stimulant use disorders, posttraumatic stress disorder, and schizophrenia/schizoaffective disorder but positively associated with diagnoses of cannabis use disorder and major depressive disorder. MS was not significantly related to homelessness. Disparities in psychosocial and psychiatric disorders among veterans with MS are described.

This study provides novel insights regarding rates of homelessness, SUD, and mental illnesses among veterans with MS. Interdisciplinary approaches to identification and management of mental illness, SUD, and homelessness among veterans with MS are critically needed.